Wrinkles: side effect of pregnancy, HRT discontinuation

Q. Why do women with more pregnancies have more facial wrinkles?

This is an interesting question. The fact that multiple pregnancies do, indeed, lead to more facial wrinkles was confirmed in a Korean study.¹

It is also interesting to note that the hormones associated with menstruation cause collagen breakdown, as well. Menstruation is the process of sloughing of the endometrium. ² It appears that menstruation requires the secretion of MMP, such as collagenase (collagenase-1, MMP-1) and gelatinase (gelatinase A, MMP-2).³ The endometrial glandular and stromal cells secrete these enzymes to allow menstrual bleeding to occur. Collagenases cleave the triple helical domain of fibrillar collagens at a neutral pH and are secreted just prior to menstruation. However, the collagenase may not only break down the fibrillar collagens present in the endometrium, but also in the dermis. This cyclic secretion of collagenases over time will decrease the collagen present in the dermis and result in facial wrinkling.

This may be one of the reasons males do not experience facial wrinkling to the same degree as females. Their bodies are not exposed to the MMP required for menstruation and pregnancy.

Q. Why do many women who have recently stopped their hormone replacement therapy due to the recent HERS and WHI reports of increased cardiovascular problems have increased skin wrinkling and decreased skin elasticity?

I have recently encountered numerous postmenopausal female patients in my practice who are concerned about their facial appearance approximately six months after discontinuing hormone replacement therapy.

They were taken off their estrogen supplements by their gynecologists after the release of the WHI trial that demonstrated an increase in cardiovascular disease, stroke, pulmonary embolism and deep venous thrombosis. I believe that this study evaluated a very narrow spectrum of estrogen effects on the female body.

There is a large body of evidence suggesting that estrogen has many beneficial effects on the skin. Estrogens have been shown to decrease facial wrinkling, but other published effects include increased skin thickness as measured by ultrasound,⁴ increased skin sebum production as measured by a Sebumeter,⁵ increased skin elasticity as measured by skin deformability using a suction device,⁶ increased skin hydration as measured by corneometry,⁷ and increased skin collagen content as measured by skin biopsy.⁸ Many methods of assessing skin function point to estrogen as a valuable replacement hormone.

Some of the beneficial skin effects of estrogen may be due to the increased production of type III collagen and an increase in the overall collagen fiber count.⁹ Estrogen also increases the acid mucopolysaccharide and hyaluronic acid levels in the skin, which are important for maintaining skin hydration and barrier function.¹⁰ The combination of increased dermal volume, due to more collagen fibers, and increased dermal hydration, due to more hyaluronic acid, may, in part, explain the decreased wrinkling noted in postmenopausal women using estrogens. It is important to note that there is currently no other substance available that delivers such documentable reproducible results in women.

Unless there are complicating circumstances, such as a personal or family history of breast cancer, other female organ cancers or embolic phenomenon, I recommend that my patients resume their estrogen hormone replacement therapy to prevent the occurrence of further facial wrinkling. There is no retinoid that I can prescribe or cosmetic procedure that I can perform which will reliably produce the skin benefits of estrogen.

1. Youn CS, Kwon OS, Won CH, Hwang EJ, Park BJ, Eun HC, Chung JH. Effect of pregnancy and menopause on facial wrinkling in women. Acta Derm Venereol. 2003;83(6):419-424.